Tracking the trajectory

Since being announced in 2012, the Moon Shots Program has launched new
approaches in surgery, targeted therapies, drug combinations and more.
Get up to speed on the progress in accelerating the end of cancer.

BY Scott Merville

Futreal holds the Robert A. Welch Distinguished University Chair and
remains on the honorary faculty of the Wellcome Trust Sanger Institute
in the United Kingdom, where he was co-director of the Cancer Genome
Project before coming to MD Anderson in 2012. He’s in charge of
integrating genomic and molecular data with clinical research. While at
Sanger, Futreal led a team that identified cancer-driving mutations in
the BRAF gene. This led to the development of targeted therapies for
patients with the mutations, as well as ERBB2 mutations active in
non-small cell lung cancer and genes active in kidney cancer.

Two years after launching the Moon Shots Program, researchers and clinicians are reporting on gains in their mission

In operating rooms, clinics, research labs and even the Texas State Capitol in Austin, innovation driven by the MD Anderson program is already impacting cancer treatment and prevention.

With a name inspired by President John F. Kennedy’s goal to put a man on the moon by the end of the 1960s, the program was launched two years ago with the goal of saving as many lives as possible, as quickly as possible. In that time, teams of researchers and clinicians have focused on six moon shots targeting eight cancers: acute myeloid leukemia (AML), myelodysplastic syndrome (MDS), chronic lymphocytic leukemia (CLL), melanoma, lung cancer, prostate cancer, and triple-negative breast and ovarian cancers — two cancers linked at the molecular level.

“This first wave of accomplishments reflects the moon shots’ emphasis on execution,” says Draetta. “It’s a matter of more efficiently applying what we already know about cancer to help our patients.”

Execution

Since receiving initial funding of $1 million each, the six moon shots teams’ accomplishments include:

Creation of an MD Anderson algorithm for deciding when ovarian cancer patients should have surgery. This systematic approach has more than doubled the rate of complete surgical removal of patients’ tumors from 25% to more than 80% of the time.

Leadership in developing targeted therapies for CLL has cut the use of debilitating chemo combinations from 48% of new patients in 2012 to 15% today.”

The first “intent to cure” clinical trial for prostate cancer, based on clinical and scientific research at MD Anderson, aims to convert periodic hormone therapy for a subset of patients into a single-episode curative regimen.

Identification by the Lung Cancer Moon Shot’s drug discovery program of two leukemia drugs with potential to treat certain lung cancer patients. A clinical trial of one of those drugs is underway.

In an important prevention milestone, the Melanoma Moon Shot provided expert information to the Texas Legislature, which led to a successful effort by a coalition of groups to persuade lawmakers to pass a statewide ban on the use of tanning beds by those under age 18.

Two new clinical trials, based on research findings at MD Anderson, aim to overcome resistance to standard-of-care therapy for myelodysplastic syndromes. One trial is the first to deploy the rising therapy of immune checkpoint blockade against leukemia.

Rocket science

The second concept of the Moon Shots Program, what Draetta calls “rocket science,” is establishing supportive platforms to provide new or additional expertise and cutting-edge technological resources.

“Rocket science enables our clinicians and scientists to make discoveries and clinical advances that really turn the world around,” he says. “Achieving that will require inventions yet to come — it will take a while.”

Moon shots research already is benefiting from new “rocket science” innovations in the fields of immunotherapy, genomics, proteomics, prevention and big data — the capacity to systematically compile and analyze massive amounts of information. The program also benefits from MD Anderson’s drug discovery and development platforms, including the Institute for Applied Cancer Science.

Learning from each patient

“A central theme of the Moon Shots Program is to learn as much as we can from every single patient,” says Andy Futreal, Ph.D., the program’s co-leader with Draetta. “We need to think longitudinally — how patients’ conditions, treatments and tumors change over time — and be smarter about how we collect and use that information.”

“You need to build an engine to learn,” Futreal says.

To do this, he leads APOLLO, short for Adaptive Patient-Oriented and Longitudinal Learning and Optimization. The technology-driven program creates a more cohesive system for standardizing long-term collection of patients’ medical history, high-quality tissue and blood samples, and genomic and molecular analyses of those samples. It’s coupled with research data and aggregated in a centralized big data warehouse.

The resulting information is available both to clinicians and researchers using advanced analytic tools such as MD Anderson’s Oncology Expert Advisor™ (OEA) powered by IBM Watson — the world’s smartest computer. Under development in the Moon Shots Program, OEA will tap MD Anderson databases and external sources of information such as scientific publications and clinical trial results at unimaginable speeds to deliver treatment recommendations in the clinic.

By seamlessly blending patient data with the latest research insights and best practices in clinical care, and analyzing it over time, APOLLO will help researchers improve patient care by understanding factors that determine treatment response, resistance, toxicity and survival.

APOLLO was piloted in Leukemia this year and is expanding to the Lung and Melanoma moon shots.

“The current model is that a scientist forms a hypothesis and writes a protocol to collect biospecimens, which come from tissue that may or may not represent exactly the same point in cancer progression for each patient or speak best to the question being asked. Next, the scientist generates molecular data from these samples, analyzes the data and eventually publishes the results,” Futreal notes. “What we’re talking about here is an effort to standardize the process and expand it to many more patients. This would mean that more traditional, hypothesis-driven investigation is significantly empowered and we move into an era of data-driven hypothesis generation around key clinical questions.

“We’re building an engine to accelerate the translational process,” Futreal says. “Every cancer research institution on the planet is struggling with this right now. Raising the quality of our information is going to benefit everyone.

“MD Anderson has an opportunity to lead.”

In its first full year of operations, MD Anderson’s Moon Shots Program has launched new approaches to ovarian cancer surgery and melanoma prevention, as well as targeted therapies and drug combinations for leukemia, prostate and lung cancer. And there’s more to come. Here are some updates.

Close to 80 million people in America currently are infected with the
human papillomavirus, more commonly known as HPV. MD Anderson doctors
are working to stop HPV-related diseases by increasing awareness and
accessibility to what some call the cancer prevention vaccine.